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2018 Online Application Form

Applicant Information

Full Name:*
Date of Birth:*
 / 
 / 
Gender:*
E-mail Address:*
Current Address:*
Postcode:*
Phone (Home):*
Phone (Mobile):*
Have you lived abroad for a period of more than 6 months in the last 3 years?*
If YES, when did you return to the UK?

Parent/Guardian Information

Name of a Parent/Guardian:*
Current Address (if different to above):
Parent/Guardian Postcode:
Parent/Guardian E-mail:*
Parent/Guardian Phone (Home):
Parent/Guardian Phone (Mobile):
Relationship to you:*

Your Educational History

Name of your current school/last school that you attended full time:*
Date of leaving OR date projected to leave: (e.g. August 2018):*
Address of the school named above:*
Please give details about which courses you are studying and your projected or actual grades:

What You Want To Study

Please choose 4 A-Level courses you would like to study, ranking them in order of preference. If you’re not sure, don’t worry – put down what you think you’d like to do and we can discuss this at interview:

First Preference:*
Second Preference:*
Third Preference:*
Fourth Preference:*

Your Motivations And Aspirations

Please explain why you want to study these courses and any career aspirations you may have at this stage? (Max 75 words)*
What attracts you most about applying for a place at Chapeltown Academy? (Max 75 words)*
Please list any enrichment activities that you currently take part in AND any enrichment activities you would like the opportunity to try or continue with at the Academy:*

Referee

Please provide details of a referee (most probably a school teacher) who we can contact for a reference:

Referee Name:*
Referee Position:*
Referee E-mail:*
Referee Phone Number:

Optional Questions

We are committed to meeting the needs of all learners. If consider yourself to have any learning difficulties or disabilities, please provide outline details:
To assist with our equal opportunity monitoring, please let us know how you would describe your ethnic origin (e.g. White British):

Information

If you have any extenuating circumstances that you believe we should know about then please attach them to this form. Applications can be scanned and emailed to contact@chapeltownacademy.com or posted to Chapeltown Academy Admissions, Chapeltown Academy, Hydra Business Park, Nether Lane, Sheffield, S35 9ZX.

Word Verification: